Healthcare Provider Details

I. General information

NPI: 1114354693
Provider Name (Legal Business Name): PAMELA PUCKETT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MORNINGSIDE DR
CONWAY AR
72034-3647
US

IV. Provider business mailing address

1125 MORNINGSIDE DR
CONWAY AR
72034-3647
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-9746
  • Fax: 501-327-2084
Mailing address:
  • Phone: 501-327-9746
  • Fax: 501-327-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD08495
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: